pg34-35 surgical applications

34 The Dentist December 2009 lasers O ne of the biggest advantages of using a laser in dentistry is the unparalleled ability to manipulate soft tissues. Due to the precise and highly targeted zone of operation it is possible to cut tissues with minimal collateral trauma. The laser can coagulate blood vessels as it cuts so there is very little bleeding, and it sterilizes as it cuts and promotes healing. The low level laser energy outside of the zone of destruction has profound physiological effects and the rate at which tissues repair post laser surgery is remarkable and there is little in the way of post treatment pain and swelling. I routinely use the laser to make incisions for aps as it gives me a nice clean operating area due to the reduced haemorrhage as well as cutting cleanly through the periosteum so I no longer shred aps. If I wish to split the tissues this is easy to accomplish and raising connective tissue grafts and free gingival grafts are relatively easy procedures. Of course soft tissue procedures such as gingivectomy are easy to accomplish and it is very convenient post surgery to carry on immediately with the denitive restorative work, due to the absence of bleeding and the absence Surgical applications Mark Cronshaw looks at the ability of lasers to manipulate soft tissues. of post treatment recession. As a matter of routine I now use the laser to trough the tissues prior to taking impressions so I end up with nice clean margins either for the optical images of the Cerec or the conventional silicone impressions I use for more exten sive crown and bridge work. There are a wide variety of soft tissue procedures I have integrated as a matter of routine into my practice as a consequence of owning a laser. T ake for example frenect omy. This is a much under-prescribed procedure with a number of important applications. These include removing a mid line frenum prior to orthodontic closure of a mid line diastema and the relief of tongue tie caused by a prominent lingual frenum. In addition I have found frenectomy invaluable in the management of gingival recession associated with a frenal pull. The obvious example of this is the frequently seen recession seen around lower central incisors. Due to a prominent frenum which impairs oral hygiene and also the mechanical pull of the frenum on the gingival tissues I often see cases of associated recession. Treatment is very straightforward as frenectomy is an easy process with the laser. Having cut the frenum I place a laser generated scar on the bone to prevent reattachment of the frenal bres. In the case of recession I also perform an additional procedure, a vestibuloplasty . This involves nothing more than opening up the post frenectomy wound at the base of the cut to create a tear shaped wound. This heals by secondary intention and in Mark Cronshaw is a private practitioner in Cowes, Isle of Wight. lProminent midline frenum- removal required prior to orthodontics. lOne week post laser frenectomy . lPolyp at right commissure. lImmediate post laser surgery . lOne week post surgery. lGingivectomy with the EZ-lase: note the absence of bleeding or inammation. The rate at which tissues repair post laser surgery is remarkable and there is little in the way of post treatment pain and swelling.

pg34-35 surgical applications

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